5 Inquiry of diet and partiality
Inquiry of diet and partiality includes the inquiry of thirst, drinking of water, intake of food and partiality.The doctors should pay attention to inquiry of thirst, quantity of drinking of water, preference for cold or hot drinks, appetite, quantity of the intake of food, partiality and aversion of food, abnormal taste and odor in the mouth. Inquiry of diet can enable one to understand whether the disease is of heat or cold, or of asthenia or sthenia, whether the functions of the spleen, stomach, liver and the gallbladder are strong or weak, whether the body fluid is sufficient or insufficient and whether the distribution of the body fluid is normal or abnormal. Such information is very important in clinical diagnosis.
1.3.3.5.1 Thirst and drinking of water
Thirst means the desire for water and drinking water means the quantity of water being drunk. Generally speaking, the patient with thirst likes to drink water and the patient without thirst does not want to drink water. But it is not always the case. In clinical diagnosis, doctors should try to inquire the characteristics of thirst and the accompanied symptoms. Whether there is thirst or not and whether the water drunk is more or less are the signs of the conditions of body fluid and its distribution.
No thirst but desire for drinking of water: This condition indicates that the body fluid is not consumed, usually seen in cold syndrome, dampness syndrome or syndrome without evident dryness and heat.
Thirst with desire to drink water: This condition is a sign of the consumption of body fluid, often seen in dryness syndrome, heat syndrome; also seen in diseases
marked by non-consumption of body fluid, dysfunction in qi transformation and failure of body fluid to flow to the upper part of the body. Extreme thirst with preference for cold drinks accompanied by reddish complexion, swearing and surging and rapid pulse is usually caused by exuberance of internal heat and serious consumption of body fluid; thirst with much drinking of water, accompanied by profuse urination, polyphagia and frequent hunger and gradual emaciation, is consumptive disease usually caused by excretion of fluid from the lower resulting from failure
of kidney to transform body fluid due to asthenia; thirst with preference for hot drinks but without much drinking of water is usually due to internal retention of phlegmatic fluid, or asthenia of yangqi and failure of body fluid to flow to the upper part of the body; thirst without much drinking of water accompanied by dull fever, heaviness of body and head and oppression in the epigastrium is usually caused by internal stagnation of damp heat, failure of body fluid to transform qi and to flow to the upper part of the body; thirst without much drinking of water accompanied by worsened fever at night and crimson tongue is yingfen syndrome in seasonal febrile disease due to invasion of pathogenic factors into yingfen which steams ying yin to flow to the upper, leading to less thirst and less drinking of water; dry mouth with desire to gargle but not to drink water, accompanied by purplish ecchymosis on the tongue, is usually caused by internal retention of blood stasis, failure of qi to transform body fluid and failure of body fluid to flow to the upper.
1.3.3.5.2 Appetite and repast
Appetite refers to the demand for food and enjoyable sensation of taking food. Repast refers to the actual amount of food being taken. Inquiry of appetite and repast is significant in understanding the conditions of the spleen and stomach and the prognosis of disease.
Reduced appetite: The meaning of reduced appetite includes anorexia. poor appetite and indigestion which are Similar to each other but are not totally the same. Reduced appetite in new disease is a sign of healthy qi fighting against pathogenic factors, indicating mild morbid condition and favourable prognosis. Reduced appetite in prolonged disease accompanied by spirihial lassitude, sallow complexion, pale tongue and Weak pulse is usually caused by weakness of the stomach and spleen to transport and transform. Reduced appetite and indigestion accompanied by heaviness of head and body, distending oppression of the epigastrium and abdomen as well as yellowish greasy fur is of ten caused by failure of the spleen to transform and transport due to dampness encumbering the spleen:
Anorexia: Anorexia means aversion to food or to the smell of food often due to retention of food in the stomach, accumulation of damp-heat in the liver, gallbladder, spleen arid Stomach. Anorexia accompanied by acid regurgitation, distending fullness of the epigastrium and abdomen is usually caused by indigestion due to retention of food in the stomach and intestines. Disliking oil and greasy food accompanied by chest oppression, vomiting anti distending fullness of the epigastrium and abdomen is often caused by indigestion due to retention of food in the stomach. Disliking greasy and rich diet accompanied by distending pain of the hypochondrium and bitter taste in the mouth is frequently caused by internal accumulation of damp heat in the liver and gallbladder. Anorexia in the gravida is due to upward adverse flow of qi in the thoroughfare vessel which prevents the stomach qi from descending. This is a normal pheriomenon. However, serious morning sickness is a commonly encountered disease seen in the course of pregnancy.
Polyphagia and frequent eating: Polyphagia and frequent eating refers to hyperorexia and hunger not long after eating, usually caused by exuberance of stomach fire and fast digestion. Polyphagia and frequent eating with emaciation is often seen in consumptive disease.
Excessive eating and frequent hunger with loose stool: This condition indicates strong function of the stomach and weak function of the spleen. Strong function of the stomach causes fast digestion which leads to excessive eating and frequent hunger; while weakness of the spleen prevents it from performing normal transportation and transformation, therefore leading to loose stool.
Hunger without desire to eat: This means that the patient feels hungry, but has no desire to eat or just eats a little food. It is usually due to insufficiency of gastric yin and internal disturbance of asthenic fire. Internal disturbance of asthenic fire leads to easiness to feel hunger; while failure of asthenic yin to moisten the stomach leads to hypofunction of the stomach to digest food. That is why there is no¡ädesire to eat.
Besides, during the course of a disease, restoration of appetite and increase of appetite are the signs of gradual restoration of gastric qi and tendency of healing. While gradual anorexia and decrease of appetite are the signs that the functions of the stomach and the spleen gradually become weak, suggesting aggravation of disease. Sudden increase of appetite or even crapulence in the patients suffering from prolonged illness or serious disease with anorexia or even inability to eat is known as "exhaustion of the gastriosplenic qi'.
1.3.3.5.3 Taste
Taste refers to the sense in the mouth. Abnormal taste in the mouth may reflect the disorders of the spleen and stomach as well as other viscera.
Bland taste in the mouth: Bland taste means hypogeusesthesia due to asthenia of gastrosplenic qi or seen in cold syndrome.
Bitter taste in the mouth: This condition is usually seen in syndromes due to exuberance of liver and gallbladder fire and upward adverse flow of gallbladder qi.
Sweet taste in the mouth: Sweet and sticky sensation in the mouth is usually caused by damp heat resulting from excessive intake of rich and sweet food; or by accumulation of exogenous damp heat in the spleen and stomach, the confliction of which with the cereal qi steams the mouth. Sweet taste in the mouth with thin fur and drooling is often caused by failure of the spleen to transport due to asthenia.
Sour taste in the mouth: Sour taste in the mouth, or acid regurgitation, is usually caused by stagnation of liver qi attacking the stomach which leads to disharmony between the liver and the stomach and failure of the gastric qi to descend.
Sour and putrid taste in the mouth: Sour and putrid taste in the mouth is usually caused by failure of the stomach and the spleen to digest, transport and transform, or by retention of food which putrefies and leads to acid regurgitation.
Puckery taste in the mouth: Puckery taste in the mouth usually appears simultaneously with dryness of the tongue, usually caused by dryness and heat consuming body fluid, or by predominant yang heat in the viscera and upward adverse flow of qi and fire.
Salty taste in the mouth: Salty taste in the mouth is usually due to asthenia of the kidney and upward flow of cold water.
Sticky and greasy taste in the mouth: Sticky and greasy taste in the mouth is usually accompanied by thick and greasy tongue fur, often caused by retention and stagnation of phlegm and damp turbidity. Sticky and greasy taste in the mouth with sweetness is usually due to damp heat in the spleen and stomach; sticky and greasy taste in the mouth with bitterness is often due to damp heat in the liver and gallbladder; sticky and greasy taste in the mouth accompanied by chest oppression, epigastric fullness and profuse and sticky sputum is due to internal accumulation of damp phlegm.
